Provider Demographics
NPI:1902292808
Name:URIBE, CESAR (MD)
Entity Type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:URIBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 CHARIDGES DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-5308
Mailing Address - Country:US
Mailing Address - Phone:956-278-6309
Mailing Address - Fax:
Practice Address - Street 1:2101 PEASE ST
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8307
Practice Address - Country:US
Practice Address - Phone:956-296-1491
Practice Address - Fax:956-389-4603
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6498207R00000X
TXBP10052483390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX391016801Medicaid
TXH088JT989OtherBCBS